NosoVeille Août 2011

NosoVeille – Bulletin de veille Février 2016
1 / 31
NosoVeille n°2
Février 2016
Rédacteurs : Nathalie Sanlaville, Sandrine Yvars
Secrétariat de rédaction : Nathalie Vincent
Ce bulletin de veille est une publication mensuelle qui recueille les publications scientifiques publiées au
cours du mois écoulé.
Il est disponible sur le site de NosoBase à l’adresse suivante :
http://www.cclin-arlin.fr/nosobase
Pour recevoir, tous les mois, NosoVeille dans votre messagerie :
Abonnement / Désabonnement
Sommaire de ce numéro :
Acinetobacter baumannii
Antibiotique / Antibiorésistance
Bactériémie
Biologie
Cathétérisme
Chirurgie
Clostridium difficile
Désinfection
EHPAD
Elizabethkingia meningoseptica
Endoscopie
Entérobactérie
Environnement
Grippe
Hygiène des mains
Infection respiratoire
Legionella
Néonatologie
Personnel
Plasmodium falciparum
Prévention
Pseudomonas aeruginosa
Soins intensifs
Staphylococcus aureus
Tenue vestimentaire
Usagers
Zika

NosoVeille – Bulletin de veille Février 2016
2 / 31
Acinetobacter baumannii
NosoBase ID notice : 407391
Etude nationale auprès des infectiologues thaïlandais sur le traitement des pneumonies à
Acinetobacter baumannii résistant aux carbapénèmes acquises sous ventilation assistée : rôle de la
sensibilisation à l’hygiène hospitalière
Buppajarntham A; Apisarnthanarak A; Khawcharoenporn T; Rutjanawech S; Singh N. National survey of Thai
infectious disease physicians on treatment of carbapenem-resistant Acinetobacter baumannii ventilator-
associated pneumonia: The role of infection control awareness. Infection control and hospital epidemiology
2016/01; 37(1): 61-69.
Mots-clés : ACINETOBACTER BAUMANNII; PNEUMONIE; VENTILATION ASSISTEE;
ANTIBIORESISTANCE; CARBAPENEME; TAUX; TRAITEMENT; MEDECIN SPECIALISTE
Objective: To evaluate the expected and treatment outcomes of Thai infectious disease physicians (IDPs)
regarding carbapenem-resistant Acinetobacter baumannii (CRAB) ventilator-associated pneumonia (VAP).
Methods: From June 1, 2014, to March 1, 2015, survey data regarding the expected and clinical success
rates of CRAB VAP treatment were collected from all Thai IDPs. The expected success rate was defined as
the expectation of clinical response after CRAB VAP treatment for the given case scenario. Clinical success
rate was defined as the overall reported success rate of CRAB VAP treatment based on the clinical practice
of each IDP. The expected and clinical success rates were divided into low (80%) categories and were then
compared with standard clinical response rates archived in the existing literature.
Results: Of 183 total Thai IDPs, 111 (60%) were enrolled in this study. The median expected and clinical
success rates were 68% and 58%, respectively. Using multivariate analysis, we determined that working in a
hospital that implemented the standard intervention combined with an intensified infection control (IC)
intervention for CRAB (adjusted odds ratio [aOR], 3.01; 95% confidence interval [CI], 1.17-7.73; P=.02) was
associated with standard and high expected rates (>60%). Being a board-certified IDP (aOR, 5.76; 95% CI,
2.16-15.37; P60%). We identified a significant correlation between expected and clinical success rates
(r=0.58; P<.001).
Conclusions: Awareness of IC among IDPs can improve physicians' expected and clinical success rates for
CRAB VAP treatment, and treatment experience impacts overall treatment success.
Antibiotique / Antibiorésistance
NosoBase ID notice : 406327
Mortalité attribuable aux infections à Klebsiella pneumoniae résistant aux carbapénèmes dans une
étude de cohorte prospective avec appariement en Italie, 2012-2013
Hoxha A; Kärki T; Giambi C; Montano C; Sisto A; Bella A; et al. Attributable mortality of carbapenem-resistant
Klebsiella pneumoniae infections in a prospective matched cohort study in Italy, 2012-2013. The journal of
hospital infection 2016/01; 92(1): 61-66.
Mots-clés : KLEBSIELLA PNEUMONIAE; MORTALITE; ANTIBIORESISTANCE; CARBAPENEME;
COHORTE; APPARIEMENT; ETUDE PROSPECTIVE; INCIDENCE; FACTEUR DE RISQUE
Background: In Italy, infections with carbapenem-resistant Klebsiella pneumoniae (CRKP) have increased
markedly since 2009, creating unprecedented problems in healthcare settings and limiting treatment options
for infected patients.
Aim: To assess the attributable mortality due to CRKP in ten Italian hospitals and to describe the clinical
characteristics of patients with an invasive CRKP and carbapenem-susceptible K. pneumoniae (CSKP)
infection.
Methods: We conducted a matched cohort study, and calculated crude and attributable mortality for CRKP.
The attributable mortality was calculated by subtracting the crude mortality rate of the patients with CSKP
from the crude mortality rate of the patients with CRKP. We also described the clinical characteristics of
CRKP and CSKP patients and analysed the determinants of mortality by using conditional Poisson
regression.
Findings: The study included 98 patients, 49 with CRKP and 49 with CSKP. CRKP patients had undergone
more invasive procedures and also tended to have more serious conditions, measured by higher Simplified
Acute Physiology Score II. The attributable mortality of CRKP at 30 days was 41%. CRKP patients were three
times more likely to die within 30 days [matched incidence rate ratio (mIRR): 3.0; 95% confidence interval

NosoVeille – Bulletin de veille Février 2016
3 / 31
(CI): 1.5-6.1]. Adjusting for potential confounders, the risk remained the same (adjusted mIRR: 3.0; 95% CI:
1.3-7.1).
Conclusion: CRKP infection had a marked effect on patient mortality, even after adjusting for other patient
characteristics. To control the spread of CRKP we recommend prioritization of control measures in hospitals
where CRKP is found.
NosoBase ID notice : 407392
Indications d’antibiothérapie et types d’antibiotiques utilisés dans 6 centres hospitaliers de court
séjour, 2009-2010 : étude d’observation rétrospective et pragmatique
Kelesidis T; Braykov N; Uslan DZ; Morgan D; Gandra S; Johannsson B; et al. Indications and types of
antibiotic agents used in 6 acute care hospitals, 2009-2010: A pragmatic retrospective observational study.
Infection control and hospital epidemiology 2016/01; 37(1): 70-79.
Mots-clés : ANTIBIOTIQUE; PRESCRIPTION; PREVALENCE; TRAITEMENT; ANTI-INFECTIEUX;
ANTIBIOPROPHYLAXIE; FLUOROQUINOLONE; VANCOMYCINE; PENICILLINE; ETUDE
RETROSPECTIVE
Background: To design better antimicrobial stewardship programs, detailed data on the primary drivers and
patterns of antibiotic use are needed.
Objective: To characterize the indications for antibiotic therapy, agents used, duration, combinations, and
microbiological justification in 6 acute-care US facilities with varied location, size, and type of antimicrobial
stewardship programs.
Design, participants, and setting: Retrospective medical chart review was performed on a random cross-
sectional sample of 1,200 adult inpatients, hospitalized (>24 hrs) in 6 hospitals, and receiving at least 1
antibiotic dose on 4 index dates chosen at equal intervals through a 1-year study period (October 1, 2009-
September 30, 2010).
Methods: Infectious disease specialists recorded patient demographic characteristics, comorbidities,
microbiological and radiological testing, and agents used, dose, duration, and indication for antibiotic
prescriptions.
Results: On the index dates 4,119 (60.5%) of 6,812 inpatients were receiving antibiotics. The random sample
of 1,200 case patients was receiving 2,527 antibiotics (average: 2.1 per patient); 540 (21.4%) were
prophylactic and 1,987 (78.6%) were therapeutic, of which 372 (18.7%) were pathogen-directed at start. Of
the 1,615 empirical starts, 382 (23.7%) were subsequently pathogen-directed and 1,231 (76.2%) remained
empirical. Use was primarily for respiratory (27.6% of prescriptions) followed by gastrointestinal (13.1%)
infections. Fluoroquinolones, vancomycin, and antipseudomonal penicillins together accounted for 47.1% of
therapy-days.
Conclusions: Use of broad-spectrum empirical therapy was prevalent in 6 US acute care facilities and in most
instances was not subsequently pathogen directed. Fluoroquinolones, vancomycin, and antipseudomonal
penicillins were the most frequently used antibiotics, particularly for respiratory indications.
NosoBase ID notice : 406690
Infections sur prothèse articulaire : une revue microbiologique
Lalremruata R. Prosthetic joint infection: A microbiological review. Journal of medical society 2015/09; 29(3):
120-128.
Mots-clés : PROTHESE; PROTHESE ARTICULAIRE; FACTEUR DE RISQUE; BACTERIE A GRAM
NEGATIF; BACTERIE A GRAM POSITIF; STAPHYLOCOCCUS AUREUS; CANDIDA; ANTIBIOTIQUE;
ANTIBIOTHERAPIE; REVUE DE LA LITTERATURE
Joint replacement is a highly effective intervention that significantly improves patients’ quality of life, providing
symptom relief, restoration of joint function, improved mobility, and independence. Prosthetic joint infection
(PJI) remains one of the most serious complications of prosthetic joint implantation. PJI positions a
substantial burden on individuals, communities, and the health-care system, and thus early diagnosis and
appropriate intervention are extremely important. Determining the various host and environmental factors that
put an individual at risk for development of PJI may reduce the morbidity and cost of total joint arthroplasties.
Microbial agents implicated in the causation of PJI range from Grampositive to Gram-negative bacteria. PJI
with fungi is commonly seen in immunocompromised patients. Numerous novel, uncultivable, and fastidious
organisms have been identified as potential pathogens with the use of non-culture techniques. The majority of
cases of PJI require surgical treatment, while the use of antimicrobials is essential when prosthetic removal is

NosoVeille – Bulletin de veille Février 2016
4 / 31
not possible or contraindicated. The microbiology and treatment of PJI in the light of improved culture and
diagnostic methods are reviewed.
NosoBase ID notice : 405981
Impact des infections à Escherichia coli ou Klebsiella pneumoniae producteurs de bêta-lactamases à
spectre étendu sur l’évolution et les coûts d’hospitalisation
Maslikowska JA; Walker SA; Elligsen M; Mittmann N; Palmay L; Daneman N; et al. Impact of infection with
extended-spectrum β-lactamase-producing Escherichia coli or Klebsiella species on outcome and
hospitalization costs. The journal of hospital infection 2016/01; 92(1): 33-41.
Mots-clés : ESCHERICHIA COLI; KLEBSIELLA PNEUMONIAE; COUT; SEJOUR; BETA-LACTAMASE A
SPECTRE ELARGI; MORTALITE; MICROBIOLOGIE; ETUDE RETROSPECTIVE; CAS TEMOIN; DUREE
DE SEJOUR; ANTIBIOTIQUE; TRAITEMENT
Background: Extended-spectrum β-lactamase (ESBL)-producing bacteria are important sources of infection;
however, Canadian data evaluating the impact of ESBL-associated infection are lacking.
Aim: To determine whether patients infected with ESBL-producing Escherichia coli or Klebsiella species
(ESBL-EcKs) exhibit differences in clinical outcome, microbiological outcome, mortality, and/or hospital
resource use compared to patients infected with non-ESBL-producing strains.
Methods: A retrospective case-control study of 75 case patients with ESBL-EcKs matched to controls infected
with non-ESBL-EcKs who were hospitalized from June 2010 to April 2013 was conducted. Patient-level cost
data were provided by the institution's business office. Clinical data were collected using the electronic
databases and paper charts.
Findings: Median infection-related hospitalization costs per patient were greater for cases than controls
(C$10,507 vs C$7,882; median difference: C$3,416; P=0.04). The primary driver of increased costs was
prolonged infection-related hospital length of stay (8 vs 6 days; P=0.02) with patient location (ward, ICU) and
indirect care costs (including costs associated with infection prevention and control) as the leading cost
categories. Cases were more likely to experience clinical failure (25% vs 11%; P=0.03), with a higher all-
cause mortality (17% vs 5%; P=0.04). Less than half of case patients were prescribed appropriate empiric
antimicrobial therapy, whereas controls received adequate initial treatment in nearly all circumstances (48%
vs 96%; P<0.01).
Conclusion: Patients with infection caused by ESBL-EcKs are at increased risk for clinical failure and
mortality, with additional cost to the Canadian healthcare system of C$3,416 per patient.
NosoBase ID notice : 407371
Epidémiologie des colonisations et infections à Klebsiella pneumoniae résistant aux carbapénèmes
chez les résidents d’un établissement de longue durée
Mills JP; Talati NJ; Alby K; Han JH. The epidemiology of carbapenem-resistant Klebsiella pneumoniae
colonization and infection among long-term acute care hospital residents. Infection control and hospital
epidemiology 2016/01; 37(1): 55-60.
Mots-clés : KLEBSIELLA PNEUMONIAE; ANTIBIORESISTANCE; CARBAPENEME; INFECTION
NOSOCOMIALE; EPIDEMIOLOGIE; COLONISATION; FACTEUR DE RISQUE; TAUX; SOIN DE LONGUE
DUREE; CAS-TEMOIN
Objective: An improved understanding of carbapenem-resistant Klebsiella pneumoniae (CRKP) in long-term
acute care hospitals (LTACHs) is needed. The objective of this study was to assess risk factors for
colonization or infection with CRKP in LTACH residents.
Methods: A case-control study was performed at a university-affiliated LTACH from 2008 to 2013. Cases
were defined as all patients with clinical cultures positive for CRKP and controls were those with clinical
cultures positive for carbapenem-susceptible K. pneumoniae (CSKP). A multivariate model was developed to
identify risk factors for CRKP infection or colonization.
Results: A total of 222 patients were identified with K. pneumoniae clinical cultures during the study period; 99
(45%) were case patients and 123 (55%) were control patients. Our multivariate analysis identified factors
associated with a significant risk for CRKP colonization or infection: solid organ or stem cell transplantation
(OR, 5.05; 95% CI, 1.23-20.8; P=.03), mechanical ventilation (OR, 2.56; 95% CI, 1.24-5.28; P=.01), fecal
incontinence (OR, 5.78; 95% CI, 1.52-22.0; P=.01), and exposure in the prior 30 days to meropenem (OR,
3.55; 95% CI, 1.04-12.1; P=.04), vancomycin (OR, 2.94; 95% CI, 1.18-7.32; P=.02), and metronidazole (OR,
4.22; 95% CI, 1.28-14.0; P=.02).

NosoVeille – Bulletin de veille Février 2016
5 / 31
Conclusions: Rates of colonization and infection with CRKP were high in the LTACH setting, with nearly half
of K. pneumoniae cultures demonstrating carbapenem resistance. Further studies are needed on
interventions to limit the emergence of CRKP in LTACHs, including targeted surveillance screening of high-
risk patients and effective antibiotic stewardship measures.
NosoBase ID notice : 407369
Augmentation de l’incidence des Escherichia coli producteurs de β-lactamase à spectre étendu dans
les hôpitaux locaux de tout le sud-est des Etats Unis
Thaden JT; Fowler VG; Sexton DJ; Anderson DJ. Increasing incidence of extended-spectrum β-lactamase-
producing Escherichia coli in community hospitals throughout the Southeastern United States. Infection
control and hospital epidemiology 2016/01; 37(1): 49-54.
Mots-clés : ESCHERICHIA COLI; KLEBSIELLA PNEUMONIAE; BETA-LACTAMASE A SPECTRE ELARGI;
INFECTION NOSOCOMIALE; INFECTION COMMUNAUTAIRE; INCIDENCE; TAUX; SOIN INTENSIF;
ETUDE RETROSPECTIVE
Objective: To describe the epidemiology of extended-spectrum β-lactamase (ESBL)-producing Escherichia
coli (ESBL-EC) and Klebsiella pneumoniae (ESBL-KP) infections
Design: Retrospective cohort
Setting: Inpatient care at community hospitals
Patients: All patients with ESBL-EC or ESBL-KP infections
Methods: ESBL-EC and ESBL-KP infections from 26 community hospitals were prospectively entered into a
centralized database from January 2009 to December 2014.
Results: A total of 925 infections caused by ESBL-EC (10.5 infections per 100,000 patient days) and 463
infections caused by ESBL-KP (5.3 infections per 100,000 patient days) were identified during 8,791,243
patient days of surveillance. The incidence of ESBL-EC infections increased from 5.28 to 10.5 patients per
100,000 patient days during the study period (P=.006). The number of community hospitals with ESBL-EC
infections increased from 17 (65%) in 2009 to 20 (77%) in 2014. The median ESBL-EC infection rates among
individual hospitals with ≥1 ESBL-EC infection increased from 11.1 infections/100,000 patient days (range,
2.2-33.9 days) in 2009 to 22.1 infections per 100,000 patient days (range, 0.66-134 days) in 2014 (P=.05).
The incidence of ESBL-KP infections remained constant over the study period (P=.14). Community-
associated and healthcare-associated ESBL-EC infections trended upward (P=.006 and P=.02, respectively),
while hospital-onset infections remained stable (P=.07). ESBL-EC infections were more common in females
(54% vs 44%, P<.001) and Caucasians (50% vs 40%, P<.0001), and were more likely to be isolated from the
urinary tract (61% vs 52%, P<.0001) than ESBL-KP infections.
Conclusions: The incidence of ESBL-EC infection has increased in community hospitals throughout the
southeastern United States, while the incidence of ESBL-KP infection has remained stable. Community- and
healthcare-associated ESBL-EC infections are driving the upward trend.
NosoBase ID notice : 406331
Prévention et contrôle de bactéries multirésistantes aux antibiotiques : recommandations d’un
groupe de travail
Wilson APR; Livermore DM; Otter JA; Warren RE; Jenks P; Enoch DA; et al. Prevention and control of multi-
drug-resistant Gram-negative bacteria: recommendations from a Joint Working Party. The journal of hospital
infection 2016/01; 92(Suppl. 1): S1-S44.
Mots-clés : PREVENTION; MULTIRESISTANCE; CONTROLE; BACTERIE A GRAM NEGATIF;
RECOMMANDATIONS DE BONNE PRATIQUE; SURVEILLANCE; DEPISTAGE; EPIDEMIOLOGIE;
PREUVE
Multi-drug-resistant (MDR) Gram-negative bacterial infections have become prevalent in some European
countries. Moreover, increased use of broad-spectrum antimicrobial agents selects organisms with resistance
and, by increasing their numbers, increases their chance of spread. This report describes measures that are
clinically effective for preventing transmission when used by healthcare workers in acute and primary
healthcare premises. Methods for systematic review 1946-2014 were in accordance with SIGN 50 and the
Cochrane Collaboration; critical appraisal was applied using AGREEII. Accepted guidelines were used as part
of the evidence base and to support expert consensus. Questions for review were derived from the Working
Party Group, which included patient representatives in accordance with the Patient Intervention Comparison
Outcome (PICO) process. Recommendations are made in the following areas: screening, diagnosis and